Definition — Masseteric Space Abscess: A masseteric space abscess is a localized collection of pus within the masseteric compartment, commonly secondary to odontogenic infection (especially mandibular molars), trauma, or spread from adjacent fascial spaces. It is characterized by painful swelling over the masseter region, trismus (restricted mouth opening), fever, and localized tenderness. Early recognition and drainage are critical to prevent extension into adjacent parapharyngeal or masticator spaces.
Ultrasound Report — Line: The masseteric space shows a well-defined hypoechoic to anechoic collection within the substance of the masseter muscle, measuring approximately 28 × 22 × 18 mm. The lesion shows internal low-level echoes and debris with posterior acoustic enhancement. Peripheral hyperechoic rim with increased vascularity on color Doppler is noted, consistent with inflammatory hyperemia. Adjacent soft tissue edema and loss of normal muscle architecture are present. No extension into the parotid or submandibular space identified. No evidence of underlying vascular thrombosis or bony erosion seen.
Conclusion: Findings are consistent with a Masseteric Space Abscess with associated cellulitis.
Recommendation: Recommend prompt clinical and surgical evaluation for incision and drainage or ultrasound-guided aspiration, depending on accessibility and clinical status.
Sonographic Features — Masseteric Space Abscess:
- Collection: Well-defined hypoechoic/anechoic lesion within masseter muscle with internal echoes and posterior acoustic enhancement.
- Rim: Peripheral hyperechoic rim with increased vascularity on color Doppler.
- Soft tissue: Surrounding inflammatory edema and loss of normal muscle echotexture.
- Associated cellulitis: Diffuse thickening of adjacent tissues with streaky hypoechoic changes.
- Extension: Evaluate for spread into submasseteric, pterygomandibular, or parapharyngeal spaces.
- Hypoechoic well-defined collection within masseter muscle.
- Internal echoes with posterior acoustic enhancement.
- Peripheral vascular rim on Doppler.
- Edema of adjacent tissues with loss of fascial definition.
Causes / Etiology — Masseteric Space Abscess:
- Odontogenic infection (mandibular molar periapical abscess — most common).
- Post-traumatic or post-extraction infection.
- Spread from adjacent fascial space infections (submasseteric, pterygomandibular, buccal).
- Systemic immunocompromised states (diabetes, immunosuppression).
Symptoms / Clinical Features — Masseteric Space Abscess:
- Swelling over masseter region.
- Pain, tenderness, erythema, and induration.
- Trismus (restricted mouth opening).
- Fever, malaise, and leukocytosis.
- May extend to parapharyngeal space if untreated.
Diagnostic Strategy — Masseteric Space Abscess:
- Ultrasound: First-line for detecting collections within the masseter muscle.
- CT/MRI: Useful to evaluate extension into masticator and parapharyngeal spaces.
- Differential diagnosis: Cellulitis, myositis, hematoma, neoplasm.
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Masseteric Space Abscess: Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.
Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.
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